<form method="post" action="/application/purchaseOrder"
	class="form-inline">
	<div id="purchaseErrorModal" class="modal hide fade" tabindex="-1" role="dialog"
		aria-labelledby="purchaseErrorModalLabel" aria-hidden="true">
		<div class="modal-header">
			<button type="button" class="close" data-dismiss="modal"
				aria-hidden="true">×</button>
			<h3 id="purchaseErrorModalLabel">Please correct your input fields</h3>
		</div>
		<div class="modal-body">
			<div>
				<div class="controls">
					<input class="span3" type="text" placeholder="First name*"
						name="firstName" value="${flash.firstName}"> <span
						class="error">#{error 'firstName' /}</span>
				</div>
				<div>
					<input class="span3" type="text" placeholder="Last name*"
						name="lastName" value="${flash.lastName}"> <span
						class="error">#{error 'lastName' /}</span>
				</div>
				<div class="controls controls-row">
					<input class="span2" type="text" placeholder="Street*"
						name="street" value="${flash.street}"> <input
						class="span1" type="text" placeholder="No.*" name="streetNo"
						value="${flash.streetNo}"> <span class="error">&nbsp;#{error
						'street' /}</span> <span class="error">#{error 'streetNo' /}</span>
				</div>
				<div class="controls controls-row">
					<input class="span1" type="text" placeholder="Code*"
						name="postalCode" value="${flash.postalCode}"> <input
						class="span2" type="text" placeholder="City*" name="city"
						value="${flash.city}"> <span class="error">&nbsp;#{error
						'postalCode' /}</span> <span class="error">#{error 'city' /}</span>
				</div>
				<div>
					<input class="span3" type="text" placeholder="Phone*" name="phone"
						value="${flash.phone}"> <span class="error">#{error
						'phone' /}</span>
				</div>
				<div>
					<input class="span3" type="text" placeholder="E-mail*" name="email"
						value="${flash.email}"> <span class="error">#{error
						'email' /}</span>
				</div>
				#{if (flash.paymentMethod == 'creditCard')}
				<div>
					<input class="span3" type="text" placeholder="Credit card No*"
						name="creditCardNo" value="${flash.creditCardNo}"> <span
						class="error">#{error 'creditCardNo' /}</span>
				</div>
				#{/if}
				<div>
					<input type="hidden" name="paymentMethod"
						value="${flash.paymentMethod}"> <input type="hidden"
						name="isMale" value="${flash.isMale}"> <input
						type="hidden" name="delivery" value="${flash.delivery}">
				</div>
			</div>
		</div>
		<div class="modal-footer">
			<button class="btn" data-dismiss="modal" aria-hidden="true">Close</button>
			<button class="btn btn-primary">Purchase</button>
		</div>
	</div>
</form>